1. 01 November 2011 Helen Tata, WHO/EMP/MAR WHO Technical Briefing seminar Geneva, 31 Oct– 04 November 2011. Access Framework & Challenges in Medicines Supply Systems Mrs Helen Tata (WHO/EMP)

2. 01 November 2011 Helen Tata, WHO/EMP/MAR Ensuring access to essential medicines - framework for collective action 1. Rational selection and use 4. Reliable health and supply systems 2. Affordable prices 3. Sustainable financing ACCESS

3. 01 November 2011 Helen Tata, WHO/EMP/MAR Architecture Access Availability Affordabilit y Adoption Pharmaceutical Supply system and access to medicines Adapted from Frost and Reich, 2008

4. 01 November 2011 Helen Tata, WHO/EMP/MAR Frost and Reich Framework Components include: Architecture: systems, structures, relationships that coordinate the remaining three e.g – human resources, regulation, donor coordination; Availability: activities that lead to medicines availability including manufacturing, forecasting, procurement, distribution and delivery; Affordability: affordability across the supply system from government to end user; and Adoption: processes that influence the demand for medicines, prescribing and use of medicines.

5. 01 November 2011 Helen Tata, WHO/EMP/MAR Assessment of medicines supply systems In 2007 selected countries in AFRO decided to assess the functioning their country architecture They had as objectives to: –map financial flows for in-country medicines procurement and distribution –provide an overview of all stakeholders involved in in-country medicines procurement and distribution –present a synopsis of in-country medicines procurement and distribution pathway –review strengths and weaknesses of existing in- country medicines supply management system

6. 01 November 2011 Helen Tata, WHO/EMP/MAR Assessment tools WHO/AFRO and EMP developed tools to support countries' assessment Two sets of questionnaires developed: 1.To map medicines financial flows & distribution 2.To assess medicines supply system around areas of medicines management cycle.

7. 01 November 2011 Helen Tata, WHO/EMP/MAR Source: Bergis Schmidt-Ehry, GTZ Mapping Results

8. 01 November 2011 Helen Tata, WHO/EMP/MAR Source Of Funds Procurement Agent/Body Point of 1 st warehousing Point of 2 nd warehousing MEDICAL STORE Medicines supply systems in TANZANIA. 2007 PRIMARY HEALTH CARE FACILITY DISTRICT STORE ZONAL MEDICAL STORE ESSENTIAL MEDICINES ARVsMALARIATBOI ARVs Ped REAGENT Blood safety (+ HIV test) VACCINESCONDOMSCONTRACEPTIVES MEDICAL SUPPLIES REGIONAL/DISTRIC T VACCINE STORE HEALTH FACILITY GOVERNMENT MULTILATERAL DONOR BILATERAL DONOR NGO/PRIVATE AXIOS TEC &CC T CRSIMACUAMMHOSPITALCOLUMBIA HOSPITAL TEC &CC T HEALTH FACILITY HOSPITAL TEC &CC T ZONAL BLOOD SAFETY CENTRE Point of Distribution GOVERNMENT WBWB GLOBAL FUND SIDASIDA PEPFARPEPFAR USAIDUSAID UNICEFUNICEF WHOWHO ABBOTTABBOTT CSSCCSSC COLUMBIACOLUMBIA PFIZERPFIZER JICAJICA CLINTONCLINTON UNITAIDUNITAID CIDACIDA CDCCDC GAVIGAVI CUAMMCUAMM HAVARDHAVARD NORADNORAD HOSPITAL TEC & CCT CLINTONCLINTON HAVARDHAVARD MEDICAL STORE CRSCRS SCMSSCMS EGPAFEGPAF MOH & SW AXIOSAXIOS UNICEFUNICEF JICAJICA CDCCDC COLUMBIACOLUMBIA ABBOTTABBOTT GAVIGAVI CUAMMCUAMM CROWN AGENTS USAIDUSAID TMAPTMAP AXIOSAXIOS United Republic of Tanzania PATIENT

9. 01 November 2011 Helen Tata, WHO/EMP/MAR Sources de Financement Structure d'appro- visionnement 1er point de stockage 2ème point de stockage Structure dispensatrice ETATETAT BMBM FONDS MONDIAL CAMEBUCAMEBU DFIDDFID UEUE USAIDUSAID FNUAPFNUAP IPPFIPPF MSFMSF OMSOMS GFA GFA CEPBUCEPBU GVCGVC UNICEFUNICEF CLINTONCLINTON GTZGTZ GDFGDF CTBCTB CAMEBUCAMEBU IPAIPA ACFACF CONCERNCONCERN CAMEBU PNLOMSF PNLT CICR CEPBU IMC BPS GVCACF CORDAID Systèmes d'approvisionnement des produits pharmaceutiques au BURUNDI. Juillet 2007 Site de prise en charge CDS SNT/CNTCDT/CTCOCOLSBPS CPLS CDV Détaillants CDS Site de prise en charge PNSRCPLS Grossiste Privé CNTS CDV PNSR ACF CORDAID IMC GVC CONCERN PEVPSI PDMPDM CICRCICR SEP/ CNLS PNLTPNLT PSIPSI UNICEFUNICEF OMSOMS FNUAPFNUAP MSFMSF ACFACF PDMPDM CICRCICR CEPBUCEPBU CORDAIDCORDAID GVCGVC GTZGTZ CLINTONCLINTON UNITAIDUNITAID GDFGDF CTBCTB CONCERNCONCERN GAVIGAVI KFWKFW IPPFIPPF PSIPSI MEDICAMENTS ESSENTIELS ARVsPALUDISMETBIO ARVs Ped REACTIFS sécurité du sang (+ test HIV) VACCINSPréservatifsContraceptifs Dispositifs Médicaux CORDAIDCORDAID SEP/ CNLS ABUBEF PRISONHÔPITAUX République du Burundi Ministère de la Santé Publique Etat Bailleurs multilatéraux Bailleurs bilatéraux ONG/Privé PATIENT

10. Supply system challenges (1) Selection: –Supply outside the EML/STG still exists –Procurement of non registered medicines in countries still exists Quantification: –CMS rarely involved in forecasting/procurement –Lack of coordination in planning between MoH/CMS and all partners results in stock-outs, shortages, overstocking and expired products –Adequate logistic information system not in place (due to the complexity of the system?)

11. 01 November 2011 Helen Tata, WHO/EMP/MAR Challenges (2) Procurement: –Managed by various partners present in country. –National system hardly in involved in program procurement Storage/stock management: –Inadequate storage capacity due to lack of coordination in procurement planning –Different stock management tools for the same product originating from different partners Distribution: –Inadequate funds for distribution. –Uncoordinated distribution between different programs leading to high operational costs for all programs.

12. 01 November 2011 Helen Tata, WHO/EMP/MAR Challenges (3)‏ Financing: –Funds available mainly for 3 disease programs –Other areas under funded (e.g. NCD etc) –Financial figures not always available –Logistic support is under- funded Monitoring-Evaluation: – Each program may have a stand alone M&E –Different reporting tools –High burden of work for scare human resources at periphery

13. 01 November 2011 Helen Tata, WHO/EMP/MAR What can be done?

14. 01 November 2011 Helen Tata, WHO/EMP/MAR Source: Bergis Schmidt-Ehry, GTZ How feasible in the supply system?

15. 01 November 2011 Helen Tata, WHO/EMP/MAR Benefits of coordinated supply  Platform for dialogue, information sharing and coordination  Joint M & E and reporting  Reduced workload  Health System strengthening  Timely delivery of medicines to target population  Cost savings

16. 01 November 2011 Helen Tata, WHO/EMP/MAR Expectations Adequate funding to medicines for priority disease to support distribution of all other categories of medicines Stock management tools for medicines from various sources streamlined No stock outs in any health facility Un-interrupted access to medicines!

17. 01 November 2011 Helen Tata, WHO/EMP/MAR Questions Any questions?

18. 01 November 2011 Helen Tata, WHO/EMP/MAR Source: Bergis Schmidt-Ehry, GTZ Could be feasible in the supply system if..